Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Provena Service Corporation

Organization Pediatrics Physician · NPI 1255526687

Provena Service Corporation is a Pediatrics Physician in Danville, Illinois. Licensed in Illinois. Registered with an NPI since 2007.

Licensed in
IL
In the registry since
2007

Practice location Address checks out

102 N Logan Ave
Danville, IL 61832-8513
Phone: (217) 442-5863
Fax: (217) 442-5040
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X (IL)

Record details

NPI number1255526687
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvena Service Corporation
Authorized official Daniel Boland — Financial Reporting Manager · (815) 806-3111
Other names Provena Medical Group
NPI enumeratedSeptember 10, 2007
Last updated in NPPESApril 20, 2008
Mailing address9223 W Saint Francis Rd, Frankfort, IL 60423-8330

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